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EDITORIAL: Healthcare Reforms in Nigeria; A Mere Political Statement Lacking Commitment

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By  Manny Ita

Nigeria has since her independence in 1960 had a very robust verbiage or policies by successive gobernments on health reforms but with very little progress or success recorded in what might well be a lack of political will in reforming the health sector.
Over 90% of the Nigerian population are without health insurance coverage. The inability to effectively address the country’s numerous public health challenges has contributed to the persistent and high level of poverty and weakness of the health system.
Political instability, corruption, limited institutional capacity and an unstable economy have also been major factors responsible for the poor development of health services in Nigeria. Households and individuals in Nigeria bear the burden of a dysfunctional and inequitable health system – delaying or not seeking health care and having to pay out of pocket for health care services that are not affordable.
The health challenges of the country include:
National Health Insurance Scheme (NHIS),
National Immunisation Coverage Scheme (NICS),
Midwives Service Scheme (MSS)
Nigerian Pay for Performance scheme
After many attempts at implementing legislation on health insurance since 1960, NHIS, although established in 1999, was eventually launched only in 2005 with the goals to ensure access to quality health care services, provide financial risk protection, reduce rising costs of health care services and ensure efficiency in health care through programmes such as the: Formal Sector Social Health Insurance Programme (FSSHIP), Mobile Health, Voluntary Contributors Social Health Insurance Programme (VCSHIP), Tertiary Institution Social Health Insurance Programme (TISHIP), Community Based Social Health Insurance Programme (CBSHIP), Public Primary Pupils Social Health Insurance Programme (PPPSHIP), and the provision of health care services for children under 5 years, prison inmates, disabled persons, retirees and the elderly.
The NHIS was expected to provide social and financial risk protection by reducing the cost of health care and providing equitable access to basic health services with the most vulnerable populations in Nigeria including children, pregnant women, people living with disabilities, elderly, displaced, unemployed, retirees and the sick.
Free health care services and exemption mechanisms are expected to provide financial risk protection for the most vulnerable populations but evidence suggest that they are ineffective and have failed to achieve this aim.
The maternal mortality ratio for Nigeria remain quite high at 814 per 100000 live births according to 2016 World Health Statistics. Across the country, pregnant women and children under five years are generally charged fees when accessing health care services, despite the federal government’s declaration of free health for pregnant women and children under five years in 2005.
The Minister of Health, Professor Isaac Adewole in 2016 announced the Federal Government’s plan to provide free health services to 100 million Nigerians in the next two years. Under this new health agenda, pregnant women across Nigeria are expected to enjoy free maternal and delivery services at the primary health care (PHC) level.
Unfortunately, Free health care services and exemption mechanisms often arise as campaign promises of political actors to the electorate and fall short in meeting the health needs of the most vulnerable populations. According to Nigeria Demographic Health Survey (NDHS) in 2013, over 60% of pregnant women aged 15-49 deliver their babies at home without any antenatal care visits. In rural areas, this value reaches 76.9%. The situation is critical in North East and North West regions of Nigeria where over 79% of pregnant women age 15-49 deliver their babies at home. Over 60% of pregnant women in Bayelsa, Plateau and Niger deliver at home rather than a health facility.
The cost of health care and the low quality of care by the public have been argued to be the reason for the poor utilisation of maternal and child health services in Nigeria.
In addition, health spending in Nigeria is low and this is responsible for the over-reliance on out of pocket payments for health care services.
Despite its launch in 2005, NHIS covers less than 10% of the Nigerian population leaving the most vulnerable populations at the mercy of health care services that are not affordable. This means the most vulnerable populations in Nigeria are not provided with social and financial risk protection. Poor people constitutes about 70% of the Nigerian population. They lack access to basic health services, which social and financial risk protection should provide, because they cannot afford it.
CBSHIP was expected to meet their health needs as well as provide social and financial risk protection to this group, which mostly reside in rural areas. As evidenced in the high rate of out of pocket payments for health care services , poor people financially contribute more to health care than official care and funds programmes in Nigeria. Out of pocket payments for health care services limit the poor from accessing and utilising basic health care services.
The quality of health care services delivered is poor and remains a huge source of concern. Most of the PHC facilities that are supposed to meet the health needs of the poor and rural dwellers are in a poor state due to poor budgetary allocation.
In trying to solve these issues, healthcare in the country must be tackled headlong in order to stem the detyeriorating development therein, which could portend grave danger for citizens of the country in the no-ditant future.
Policy makers and political actors need to devise health care reforms to address the lack of social and financial protection for the poor and vulnerable populations. Part of this reform is the expansion of the NHIS. States should be mandated to provide health insurance coverage to all residents. Making health insurance optional for states over the years has affected the ability of the NHIS to increase the level of coverage for the people.
While the mandatory CBHI scheme is being scaled-up as a supplementary measure, state governments should enrol poor residents in a private health insurance plan and bear the responsibility of paying the monthly premium per person to Health Maintenance Organisations (HMOs). It is not enough to have a national health insurance policy, it is important to ensure that health insurance coverage is provided to the poor and most vulnerable populations as a matter of the human right to health.
Although the NHIS Act made provision for children, who constitute the largest population in Nigeria, many children still have to pay for health care services in spite of being born into poor families that do not have the ability to pay for health care services and suffer financial hardship as a consequence. The free health policies and exemption mechanisms provided by some states, targeted at children, pregnant women and the elderly, are not social and financial risk protection policies, as these groups are largely responsible for the cost of health care with the free health care programme barely covering their basic health care services.
Another way of providing social and financial risk protection for poor and vulnerable populations is by establishing a legislative framework for a UHC scheme and setting aside funds for it. Evidence from Thailand has shown the effect of UHC schemes through PHC on expanding access to health care for the poor and vulnerable populations.
Political actors, policy makers and all stakeholders in the health sector should establish a government funded social and financial risk protection scheme through a general tax financing system for the poor and vulnerable, and invest in basic infrastructure for health care in rural areas for quality health care service delivery. UHC schemes are important in addressing the problem of poor coverage, limited access to health care, and poor quality of health care services.
Nigeria is yet to adopt innovative ways to protect the poor and vulnerable populations against financial risk of ill health. It is important to guarantee by law the right to health care of all citizens in Nigeria. Although the National Health Act (NHA) that was signed into law in 2014 stated that all Nigerians are entitled to basic minimum package of health care services, it is not clear if the provisions made in the NHA are capable of achieving UHC in Nigeria. In addition, the NHA is yet to be implemented over two years after its signage into law.
Some low- and middle-income countries (LMICs) have been able to provide social and financial risk protection schemes for poor and vulnerable populations as a matter of the human right to health. Therefore, there is a need to provide social health protection schemes targeted at these groups in Nigeria. The poor and vulnerable populations should not become impoverished because of failure to obtain much needed health care services. Governments must reduce out of pocket payments for health care services by households through the adoption of a tax financed non-contributory UHC scheme.

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Features

Professor Charles Dokubo and the Stench of the Presidential Amnesty Programme

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“The trouble with Nigeria is simply and squarely a failure of leadership. There is nothing basically wrong with the Nigerian land or climate or water or air or anything else. The Nigerian problem is the unwillingness or inability of its leaders to rise to the responsibility, to the challenge of personal example which are the hallmarks of true leadership.”

                                                      –Chinua Achebe

The concept of leadership is universal, cutting across several boundaries. Leadership  is an important ingredient in the activities of government; the determining factor between success and failure in a society.

Because of its infinitely defining nature therefore, Leadership is serious business and essentially demands an innate ability to foresee, a commitment and dedication to serve, the selflessness to be equitable and honesty to be accountable, all of which underpin the operative words of Chinua Achebe’s quote above in ‘unwillingness or inability of leaders to rise to the responsibility’, buttressing yet that being in a position of leadership is not in itself an end, but only a means to an end.

The Niger Delta region in Nigeria, adjudged the world’s largest wetland, representing over 90% of Nigeria’s foreign exchange earnings has for as long as time been characterized by ecological squalor, high degree of unemployment, teeming youth restlessness, developmentally barren communities, and a heavy air of hopelessness, all of which have over the years been augmented by poor leadership both in the region and at the federal level.

This situation ignited appalling bloodbath, sabotaging of oil installations, kidnapping,   piracy, oil  bunkering,  guerrilla attacks on the security agents and fierce militancy which held the region spellbound for many years, causing Nigeria’s oil production at a time to drop to as low as about 900,000barrels per day from 2.3  million bpd, costing the nation about N8.7 billion daily. This was critical to the economy for a country that over 90% of its income derives from crude, with over 200 million in population.

The amnesty programme, introduced by late President Umaru Yar’Adua in 2009 has since proven to be a recipe for peace in the hitherto restive region, but that peace which paved the way for oil companies to resume normal business activities and provided the necessary boost to the oil-reliant Nigerian economy is fast becoming fragile given the documented cases of corruption in the leadership of the programme.

As it turned out, most of the militants were jobless youths, driven by their conditions into living dangerously in the creeks. The three phases of the amnesty programme being Disarmament Programme, Demobilization Programme and Reintegration Programme were thus conceieved to ultimately reintegrate these militants back into society and so they were placed on monthly stipends, made to learn trades while others secured university admissions to study in  Nigeria and abroad.

It is this reintegration phase that to a large extent shows the success or failure of the amnesty programme, and until the present regime headed by Professor Charles Dokubo, the programme seemed well on course.

Sidelining the mandate for which the Amnesty Programme was established, the leadership of the programme under leadership of Dokubo is being rampantly abused.

The programme is now obviously derailed given the festering corruption it has been caught up in and it would seem Professor Charles Dokubo does not have a good understanding of the dynamics of the program, the region or is simply too pre-occupied with inordinate interests to give a hoot.

It is sad indeed that even with the capacity of the programme to transform the economy of the region and Nigeria’s at large, its implementation has been compromised on  the platter of mediocrity and self- aggrandizement.

Several allegations of mismanagement and embezzlement of money allocated to the Presidential Amnesty Programme have been made against the office.

Thousands of beneficiaries whose names made the original list do not receive payments anymore as their names have been reportedly swapped for ghost names, while beneficiaries who await calls for their various techno-vocational training have been left in limbo.

Appearing too elitist to identify with the common people of the region whose demands have remained the same from the onset, Dokubo does not engage with the core people behind the struggle in the region as reports have it that since he was appointed to head the programme, he has never visited any state, clan or kingdom in the Niger Delta, which sounds absurd, given the place of assuring peace, development and security which are the bedrock of the amnesty programme.

Dokubo lacks the knowledge or ability to deal with the grassroots, the true ex-agitators and prefers dealing with the white-collar ivy leaguers with little knowledge of the terrain and ghost ex-agitators, thereby mortgaging the essence of the programme.

At the Kaiama Amnesty Centre, mismanagement and vandalisation of equipment worth billions of Naira in the starter Pack Warehouse at the centre is one of the sad reminders of Dokubo’s incompetence.

In like manner, the Ondo State VTC commissioned several months ago with equipment at the center worth billions of naira, lies rotting away with none ever sent there for training, while stupendous sums of money are constantly awarded for training.

There has been reports of the award of fictitious contracts going on at the agency designed to siphon money from the system; as payments are often made for supplies never delivered; with contracts sold and awarded for projects that never served the purpose of the programme.

Immorality has also reportedly gained prime place in the regime of the prof by indecent relationships with female staff and female contractors while contractors now bring women to get contracts.

Funds meant for ex- agitators’ training are wantonly looted to the extent that about nine thousand ex field agitators who still await call to be fully engaged by the government are yet to be recognized and carried along by Prof. Dokubo’s team.

What’s more, the non-payment of tuition fees of students sponsored under the amnesty programme in tertiary institutions has resulted in these students being asked to withdraw, which might well be the summit of the ignominious charade by the amnesty office.

The office of the programme is reported to currently be in debt of over 20billion Naira and still accumulating. This is clearly a pointer to leadership failure, looting and mismanagement of resources in the amnesty agency.

Chicanery in government offices is not new in Nigeria, but after holding sway for so long, the coming in of President Buhari with his gospel of anti-corruption elicited huge breaths of relief from Nigerians who have been at the receiving end of the cankerworm.

With these grave cases of corruption in the leadership of the amnesty programme of the federal government, it can  be reasonably expected that the president will be seen to take a decisive action on the matter, since the plan of the House of Representatives to set up an ad hoc committee to investigate the allegations is yet to see the light of the day for reasons not clear.

Dokubo himself alluded to the importance of working in close relationship with leaders in the region when he newly came in, but that spirit and resolve seem to have been vitiated by corruption.

According to his inaugural speech; “I have come to the conclusion that the Amnesty Programme would be better managed and better results achieved, if the managers of the Programme work very closely with leaders in the Niger Delta. In a nutshell, as the Coordinator of the Amnesty Programme, I intend to work very closely with you leaders in the region and other key stakeholders of the Amnesty Program.”

He may also unwittingly or subtly have alluded to the fact that there would be incidences of corruption when he admitted he will make mistakes.

“I am determined to radically improve on what I met on ground at the Amnesty Office. I am not perfect. I am most likely going to make mistakes along the line, especially given the peculiar nature of the Amnesty Programme.” And he did.

It is obvious that the leadership of the presidential amnesty programme has woefully failed in carrying out its mandate, and the situation demands that the government wades in urgently and put an end to the embarrassing reports of thievery and debauchery emanating from the office.

No time in the history of the programme have there been stentorian cries for the removal of its boss, as in the instant case with Dokubo, whose appointment is beginning to raise eyebrows, questioning the criteria with which he was appointed.

The Pan Niger Delta Youth Leadership (PANDLEAF) believes that leadership failure is the nucleus of the problems confronting the Niger Delta region and according to its leader, Mr. Akinawa, “We can’t fold hands as youth and expect change. The time for us to take action is now and that is the intent of PANDLEAF; to awaken the youths of the Niger Delta for common good where leaders have failed.”

Lending its voice to the rot in the amnesty programme is the Coalition of Niger Delta Ex-agitators under the auspices of Creek Dragons who have called on President Muhammadu Buhari to urgently remove the current coordinator of the programme, Prof. Charles Quaker Dokubo.

The former creek warlords in a statement released to the press maintained that Prof. Dokubo is alien to the Niger Delta struggle for emancipation, accusing him of incompetence and alleged that the entire amnesty program has become a caricature, while stressing that his removal from office will better the amnesty program in moving forward and achieving its aims and objectives.

For that matter, the office of the presidential amnesty programme is one the president should of necessity be very much interested in, as the stench of rot wafting from the office across the region it is meant to serve is becoming intolerable and stands at variance with the vision and resolve of Mr. President as it concerns uprightness and accountability in public offices.

The kind of person needed to man the affairs of the office is one well vested with knowledge about the core issues of the region and objectives of the programme as drawn by the federal government. A person who commands the respect of leaders in the region as well as the confidence of the ex-agitators. This crop of people exists but have seemingly been constantly sidelined because of the politics involved in the whole thing.

Apparently, the Profeessor may have gotten this far by his dis-ingenuity and it is not a hidden fact that he has also been expending colossal amounts of money to secure his being retained as head of the amnesty programme, but things cannot keep on going the way they are with different results expected.

Stakeholders and well-meaning Nigerians are now champing at the bit for a quick and worthy change of leadership in the office of the presidential amnesty programme.

Otherwise the fragile peace that has so far been enjoyed in the once violent region may simply crumble.

Manny Ita, a Public Affairs Commentator writes from Bayelsa.

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Security Update

SARS Is The Most Successful Unit On The Force….IG

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The Acting Inspector General (IG) of Police, Mohammed Adamu, said in Benin City on Monday that the Special Anti-Robbery Squad (SARS) has contributed up to 80 per cent of the successes recorded by the Nigeria Police Force.

Adamu made the remark at the commencement of a three-day Human Rights Training Programme for officers of SARS in Edo.

The IG, represented by CP Abiodun Odube, Commissioner of Police in charge of Training and Development, said this was in spite of the protests by Nigerians against the activities of SARS.

He noted that one area of conflict between the public and SARS was in the area of human rights.

The IG said the training was, therefore, a holistic approach to enhance the performance of the squad.

He also said that the force was committed to the training and re-training of its officers and men across the country to respect the human rights of the citizens.

According to him, the training seeks to improve professionalism of officers, who are expected to take the training down to their subordinates and the rank-and-file.

He stressed that the training was part of a holistic reform to get police personnel adequately equipped to discharge their duties and win the trust of Nigerians.

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Security Update

Kano CP Apologises To NBA Over illegal Arrest

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The Kano state Commissioner of Police, Mohammed Wakili has on Thursday apologised to the Nigerian Bar Association (NBA) over molestation and unlawful arrest of its members by policemen.

The apology came barely 24 hours to expiration of a 48-hour ultimatum by the Kano NBA to Wakili.

The Nation reports the NBA in a statement on Wednesday said armed policemen had molested and arrested its members working at an election petition secretariat.

The association also accused Wakili of being partisan in the discharge of his duty.

However, on receiving the information about the ultimatum, the commissioner appeared at the NBA secretariat on today to tender an unreserved apology.

Speaking to newsmen after the visit, Wakili said he decided to come by himself to say sorry after he investigated the incident that led to the arrest and detention of two lawyers.

“After receiving the complaint and even heard it through the media, I launched an investigation and found that they were unlawfully arrested.

“Therefore, I deemed it fit to go there myself and tender my apology. I am a Police man who discharges his duty within the concept of law,” he said.

The CP also urged the association and other people to challenge him whenever he goes contrary to law.

The state secretary of the association, Mujtaba Adamu-Ameen, commended the CP for the gesture, describing him as a professional and ethical cop.

“As you can see, the CP abided by our ultimatum. He came here and apologised. This show that he is a professional and disciplined Corp,” he said

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